| NPI | 1730397191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3953) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103TF0000X Psychologist Family | |
| 103TC0700X Psychologist Clinical (Licence: NC 3953) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-06-08 |